糖尿病肾病与非糖尿病肾病维持性血液透析患者生存率比较的历史队列研究  

A historical cohort study of the survival rate difference between diabetic kidney disease and nondiabetic kidney disease maintenance hemodialysis patients

作　　者：刘书馨[1] 金蕊 刘红[1] 王志宏[1] 滕兰波[1] 董毳 郐婷婷[1] 张瑜 Liu Shuxin;Jin Rui;Liu Hong;Wang Zhihong;Teng Lanbo;Dong Cui;Gui Tingting;Zhang Yu(Department of Nephrology,Dalian Municipal Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院肾内科,116033

出　　处：《中国医师进修杂志》2019年第9期771-776,共6页Chinese Journal of Postgraduates of Medicine

基　　金：辽宁省自然科学基金(201602219).

摘　　要：目的比较维持性血液透析患者中,原发病为糖尿病肾病患者与非糖尿病肾病患者生存率的差异。方法选取2010年1月1日至2016年12月31日大连市中心医院开始接受维持性血液透析治疗满3个月、符合入组条件的患者。根据原发病将患者分为糖尿病肾病和非糖尿病肾病组。生存时间为开始血液透析治疗至死亡的时间,删失值的定义为至随访结束时(2016年12月31日)仍存活患者、失访患者及肾移植患者。研究观察的终点事件为全因死亡。采用SPSS 13.0软件进行统计分析,生存情况分析采用Kaplan-Meier生存分析,风险评估采用单因素COX回归分析,独立性分析采用多因素COX回归,P<0.05为差异有统计学意义。结果共入选769例患者,男465例(60.5%),女304例(39.5%),患者开始透析年龄(56.2 ± 14.9)岁。糖尿病肾病组患者305例(39.7%),非糖尿病肾病组患者464例(60.3%),随访中位时间为21个月,全因死亡患者170例(21.7%)。糖尿病肾病组1、2、3、4、5、6和7年生存率为94%、77%、68%、56%、44%、31%、26%;非糖尿病肾病组1、2、3、4、5、6和7年生存率为94%、87%、81%、77%、69%、65%、60%。糖尿病肾病组与非糖尿病肾病组相比,生存率更低(χ2=23.656,P < 0.01)。多因素Cox回归分析发现,开始透析年龄、糖尿病肾病、低密度脂蛋白胆固醇、射血分数(EF)、合并冠心病、脑卒中是死亡的独立预测因子(P<0.05)。结论在维持性血液透析患者中,糖尿病肾病患者的生存率显著低于非糖尿病肾病患者。开始透析年龄、原发病、低密度脂蛋白胆固醇、EF、合并冠心病、脑卒中是维持性血液透析患者死亡的独立预测因子。Objective To compare the survival rates difference between diabetic kidney disease (DKD) and non-DKD maintenance hemodialysis patients. Methods The eligible patients who started hemodialysis treatment in Dalian Municipal Central Hospital from January 1, 2010 to December 31, 2016 were enrolled. The endpoint was all-cause death. Patients were divided into two groups according to the primary disease: DKD group and non-DKD group. Survival between two groups was compared by Kaplan-Meier plots and log-rank test. Survival was timed from the start of dialysis until the date of death and was censored for the date of end of the study period (December 31, 2016). SPSS 13.0 software was used for statistical analysis. Univariate COX regression analysis was used for risk assessment. Independent analysis was performed by multivariate COX regression. P < 0.05 indicated that the difference was statistically significant. Results A total of 769 patients were enrolled, including 305 patients with DKD (39.7%) and 464 patients with non-DKD (60.3%). There were 465 males, accounting for 60.5%, and 304 females, accounting for 39.5%. The mean age of starting dialysis was (56.2 ± 14.9) years. The median follow-up time was 21 months. One hundred and seventy patients died due to all causes, accounting for 21.7%. The 1-, 2-, 3-, 4-, 5-, 6- and 7-year survival rates in the diabetic kidney disease group were 94%, 77%, 68%, 56%, 44%, 31% and 26%. The 1-, 2-, 3-, 4-, 5-, 6- and 7-year survival rates in the non-diabetic kidney disease group were 94%, 87%, 81%, 77%, 69%, 65% and 60%. The survival rate of DKD group was significantly lower than that of non-DKD group (χ2=23.656, P < 0.01). Multivariate Cox regression analysis showed that age of onset of dialysis, primary disease, low density lipoprotein, serum potassium, ejection fraction (EF), coronary heart disease and stroke were independent risk factors of mortality (P < 0.05). Conclusions The survival rate of patients with diabetic kidney disease is significantly lower than that of patients with

关 键 词：糖尿病肾病 血液透析滤过 队列研究 生存率 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]